Fundamentals of Health Care Facility Electrical Power Systems

Transcript

Slide 1: Fundamentals Of Health Care Facility Electrical Power Systems

Welcome to Fundamentals Of Health Care Facility Electrical Power Systems.

Slide 2: Welcome

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Slide 3: Objectives

At the completion of this course you will be able to

• Recognize the importance of electrical distribution to health care facilities, and how it
differs from other types of buildings

• Identify the codes, standards and guidelines which govern the design of health care facility
electrical systems

• Describe the primary components of a health care facility’s Essential Electrical System

Slide 4: Introduction

Picture this…

Your favorite team is headed to the championship game. You’ve got plenty of food, and your
favorite drink, surrounded by your guests who are just as excited as you are. You’re sitting on your
comfy couch, your team enters the stadium and is facing their toughest opponent yet. The game is
tied, seconds to go, the star forward goes for a winning goal and WHAM! The power goes out.
Guess what? They made a HUGE play and you just missed it. UGH! What could possibly be
worse?!

We’ve all faced the consequences of an unreliable electrical system at home. These minor
inconveniences are frustrating, sure, but what happens if the power goes out, and instead of sitting
on your couch at home, you’re in surgery. Yes, that could most definitely be worse!

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 Fundamentals of Health Care Facility Electrical Power Systems
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Slide 5: Introduction

With daunting aspects such as ever-changing codes and standards, increasing medical complexity,
and dwindling capital budgets, hospitals and health care facilities are among the most challenging
building projects. Health care facility electrical systems are complex, difficult to design, expensive
to build and subject to a plethora of codes and standards as well as intensely regulated by
authorities having jurisdiction over their design and construction. With new medical technologies
continuing to arrive on the scene, healthcare facility electrical systems are ever changing.

Slide 6: The Mission

The main mission of any hospital is providing high quality services and continuity of care for
patients. Underpinning this mission are numerous complex systems, many of which require high
power availability, power reliability, power quality and secure power.

Power problems can have serious consequences on human life, finances, technical operations, the
environment, and the hospital’s image and reputation, so creating and maintaining a healthy
electrical distribution system is crucial.

Understanding how a balance between architecture, services and components can provide an
ideal solution is key to true power reliability. Typical architectures for a hospital’s electrical
distribution system can help ensure the best possible solution, and include power monitoring as a
critical component. The information from the power monitoring system can be used to manage the
electrical distribution system independently or in conjunction with other hospital infrastructure like
the building management system.

When all is said and done, the purpose of the infrastructure is to support the mission of the
organization. And in health care, that mission is caring for people.

Slide 7: Complex Healthcare Processes

Healthcare facilities are often complex and integrate several different processes, including:

• Critical medical processes: Operating rooms, intensive care, labs

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 Fundamentals of Health Care Facility Electrical Power Systems
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• Critical non-medical processes: Patient data systems (server rooms, data centers)

• Important medical processes: Hospitalization (patient rooms), therapy (such as respiratory

and physical therapy), imaging (such as CT Scans and MRIs)

• Non-critical medical: Ambulatory care

• Non-critical and not medical: Parking, cafeteria, laundry, sterilization

As a result, healthcare facilities not only rely upon common commercial types of equipment (such
as computers, servers, lighting systems) and industrial equipment (such as food preparation
equipment, laundry equipment, medical gas systems), but also rely on electronic medical
technology (medical equipment) to operate the facility and provide patient care services.

Slide 8: Differing Needs

Different types of health care facilities have differing needs and code requirements for electrical
distribution:

• Hospitals

• Long-term care facilities

• Ambulatory surgery facilities

• Outpatient therapy facilities

• Outpatient facilities

• Clinics and physician offices

Slide 9: Differing Needs

In a hospital, the care of patients, and very often their very lives are dependent on electrical power.
At any given time, there can be patients in a hospital that are on some type of electrically powered
life support equipment. Patients may be on a ventilator which is assisting them with breathing, or
perhaps breathing for them. A patient undergoing general anesthesia during surgery is unable to
breath on their own. A machine, powered by electricity breathes for them. A patient in the middle of

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 Fundamentals of Health Care Facility Electrical Power Systems
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open heart surgery can not just be taken to another hospital in the event that there is no power.
Residents at a long term care facility may or may not require life support, and even if they do not, in
the event of a complete power failure, they are not able to leave the facility on their own and go
someplace that can care for them.

In some medical facilities, a complete loss of power might not have life threatening consequences,
but could be more of an inconvenience. An example might be a physicians office or dental office.
But it is not possible to make generalizations. Some physician offices or clinics might perform
certain procedures in which least some level of back up power is warranted.

Slide 10: Differing Needs

The codes and standards governing health facilities take into account the fact that different types
of facilities have different needs, depending on the services provided in that facility. The design
requirements are tailored to achieve the necessary degree of reliability, durability, maintainability,
efficiency, and economy as appropriate. For a facility such as a hospital, long-term care facility or
ambulatory surgery facility, an alternate on-site source of power is required. The term Essential
Electrical System is used in NFPA codes and standards pertaining to health care facilities. All of a
facility normally is powered by the electric utility. If that utility fails, or if in internal component of the
normal power system fails, the on-site power source provides power to those functions that are
essential.

Slide 11: Hospital Electrical Distribution

Lets look at a hospital’s electrical distribution system.

A hospital’s electrical system consists of the normal system and the essential electrical system.
The power source for all of the loads in the building is normally the electric utility. If that utility fails,
power is provided to the Essential Electrical System (EES) from an alternate power source.

Essential electrical system for hospitals consists of an alternate source of power that is distributed
to essential loads through three distinct branches of distribution:

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 Fundamentals of Health Care Facility Electrical Power Systems
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1. The Life Safety Branch, which provides power to life safety components such as egress
lighting, exit signs, fire alarm and medical gas alarm systems.

2. Critical Branch, which provides power to the loads and functions needed to care for
patients.

3. The Equipment Branch which provides power for major electrical equipment necessary for
patient care and basic hospital operation.

Slide 12: Hospital Electrical Distribution

The importance of electrical distribution to hospitals cannot be overstated. Without electrical power,
a healthcare facility cannot operate and must be closed or evacuated. But closing and evacuating
the building can have serious consequences also. Life support is first and foremost. Think about
patients on ventilators and general anesthesia used during surgeries. These use electricity. Most
medical procedures use electricity of some sort. In the case of a hospital an immediate evacuation
is not an option except during dire circumstances.

With the advent of the electronic medical record (EMR), there has never been a more critical time
to ensure a rock solid electrical architecture that supports and strengthens the critical path
elements of EMRs, every step of the way. Most medical devices, imaging systems and laboratory
analysis systems interface to the EMR making it the hub of information essential for caring for,
diagnosing and treating a patient. EMRs allow practitioners to track data over time; identify
patients who are due for preventive visits and screenings; monitor how patients measure up to
established parameters, such as vaccinations and blood pressure readings; and improve overall
quality of care.

Slide 13: Hospital Electrical Distribution

Another important aspect to be considered: Illumination of the means of egress. If a disaster – like
an earth quake, fire, or a flood - should occur, and the hospital needs to evacuation, that path of
lights could be the only thing between the people in the building and safety.

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 Fundamentals of Health Care Facility Electrical Power Systems
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For all these reasons and more, the electrical distribution system in a heath care facility needs to
be reliable, durable and available!

Slide 14: Hospital Electrical Distribution

Codes, standards and guidelines change over time. The branches of the Essential Electrical
System we just discussed are based on the 2012 and subsequent editions of NFPA 99. Older
editions of NFPA 99 refer to the Essential Electrical System as consisting of the Equipment System
and the Emergency System, with the Emergency System then consisting of two branches, the Life
Safety Branch and the Equipment Branch. There are a few differences in the requirements
regarding the loads on the various branches of the Essential Electrical system between the 2005
and 2012 editions. No matter which edition of NFPA 99 your particular Authorities Having
Jurisdiction reference and enforce, the requirements are similar, and the Essential Electrical
system is designed to provide power from an on-site alternate power source to those loads that are
essential for caring for the patients at that medical facility.

Slide 15: Codes, Standards & Guidelines

Like most commercial and industrial buildings, health care facilities come under the jurisdiction of
local building officials, local and state fire officials, local and state elevator inspectors, and other
AHJs over specific parts of a project. Generally, hospitals come under the jurisdiction of a state
health department and a state health care licensure authority.

A health care facility that receives reimbursement from Medicare or Medicaid falls under the
authority of the Centers for Medicare & Medicaid Services (CMS) and must meet the CMS
Conditions of Participation. Health care facilities may choose to be accredited by an accrediting
organization that has deemed status, meaning that if the health care facility receives accreditation,
they are considered to be in compliance with the Conditions of Participation and can receive
Medicare and/or Medicaid reimbursement.

Examples of deemed status accrediting organizations include:

• The Joint Commission

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 Fundamentals of Health Care Facility Electrical Power Systems
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• DNV –GL

• Health Facility Accreditation Program (HFAP)

• Accreditation Association for Ambulatory Health Care (AAAHC)

Accrediting organizations have specific standards that the health care organizations must follow.
These standards are based on the nationally recognized codes and standards with which CMS
requires compliance.

As an example, a hospital accredited by the Joint Commission must comply with the Joint
Commission Environment of Care and Life Safety standards, which are in turn based on certain
National Fire Protection Associations (NFPA) codes with which CMS requires compliance.

Slide 16: Codes & Standards

Health care facilities come under the jurisdiction of different and multiple AHJs, and are required to
meet the requirements for many different codes, standards and guidelines. Each state has their
own specific requirements and often enforce different codes and standards than does CMS. It is
important to know which specific codes, standards and guidelines a health care organization is
required to follow. Following is a description of some of the codes, standards and guidelines that
pertain to health care electrical distribution systems.

NFPA 70: National Electrical Code

Adopted in all 50 states, the NEC is the benchmark for safe electrical design, installation, and
inspection to protect people and property from electrical hazards. Article 517 in the NEC provides
requirements specifically for health care facilities. Note that a new edition of the NEC is published
approximately every three years. Not all states use the same edition.

NFPA 70E: Standard for Electrical Safety in the Workplace

NFPA 70E requirements for safe work practices to protect personnel by reducing exposure to
major electrical hazards. Originally developed at OSHA's request, NFPA 70E helps companies and
employees avoid workplace injuries and fatalities due to shock, electrocution, arc flash, and arc
blast

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 Fundamentals of Health Care Facility Electrical Power Systems
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NFPA 99: Health Care Facilities Code

NFPA 99 establishes criteria for levels of health care services or systems based on risk to the
patients, staff, or visitors in health care facilities to minimize the hazards of fire, explosion, and
electricity.

NFPA 101: Life Safety Code

The Life Safety Code is the most widely used source for strategies to protect people based on
building construction, protection, and occupancy features that minimize the effects of fire and
related hazards. It covers life safety in both new and existing structures. CMS requires compliance
with the Life Safety Code, so most hospitals are required to comply with its requirements.

NFPA 110: Standard for Emergency and Standby Power Systems

This standard covers performance requirements for emergency and standby power systems
providing an alternate source of electrical power in buildings and facilities in the event that the
normal electrical power source fails. Systems include power sources, transfer equipment, controls,
supervisory equipment, and accessory equipment needed to supply electrical power to the
selected circuits. It also provides requirements for testing the essential electrical system.

NFPA 111: Standard on Stored Electrical Energy Emergency and Standby Power Systems

This standard covers performance requirements for stored electrical energy systems providing an
alternate source of electrical power in buildings and facilities in the event that the normal electrical
power source fails. Systems include power sources, transfer equipment, controls, supervisory
equipment, and accessory equipment needed to supply electrical power to the selected circuits..

Slide 17: Important Guidelines

FGI Guidelines

The Facility Guidelines Institute (FGI) is a nonprofit organization that was established in 1998 to
provide leadership and continuity to the development and publication of the Guidelines for Design
and Construction of Hospitals, and Outpatient Facilities, and the Guidelines for the Design and
Construction of Residential Health, Care and Support Facilities . These documents provide

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 Fundamentals of Health Care Facility Electrical Power Systems
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minimum standards for design and construction of hospitals and outpatient facilities. FGI functions
as a contractual, fundraising, and coordinating entity for the quad-annual Guidelines revision
process, supporting the work of the independent Health Guidelines Revision Committee in its goal
to update and improve the content of the Guidelines to encourage its adoption and use. Many
states adopt the Guidelines.

Center for Medicare and Medicaid Services (CMS)

If a health care organization wishes to receive funding through Medicare or Medicaid to provide
care for patients, the organization must be in compliance with the CMS Conditions of Participation.
This can be achieved through accreditation by an accrediting organization that has deemed status,
which means that if a health care organization is accredited by that organization, they are deemed
to be meeting the CMS Conditions of Participation. A health care organization can choose to use
one of the voluntary accreditation organizations, which will be discussed in a few moments, or they
can choose to have CMS directly inspect their facility and their processes. CMS inspections are
unannounced. CMS may perform an inspection even at a facility that is accredited by another
organization.

Occupational Safety & Health Administration (OSHA)

OSHA’s mission is to “to assure safe and healthful working conditions for working men and women
by setting and enforcing standards and by providing training, outreach, education and assistance.”
(From the OSHA website, https://www.osha.gov/about.html) OSHA’s focus is on safety of
employees and workers. There are many OSHE laws and regulations that employers must follow.
These laws and regulations cover a multitude of safety topics including personal protective
equipment, confined space entry, and lockout tagout. While health care organizations are very
focused on providing safe, effective and compassionate care for their patients, they also are
focused on providing a safe and effective workplace for their employees

Slide 18: Electrical Distribution

The 2012 Edition of NFPA 99 The Health Care Facilities Code provides requirements for the
essential electrical system. NFPA 99 defines the essential electrical system as:

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 Fundamentals of Health Care Facility Electrical Power Systems
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“A system comprised of alternate sources of power and all connected distribution systems and
ancillary equipment, designed to ensure continuity of electrical power to designated areas and
functions of a health care facility during disruption of normal power sources, and also to minimize
disruption within the internal wiring system.”

Many types of health care facilities are required to have a backup source of electrical power. As an
example, a hospital will have an essential electrical system that includes an onsite power source,
typically one or more generators, transfer switches and electrical distribution such that if there is a
power failure, the generator starts, transfer switches activate and power to critical loads is provided
by the generator.

Slide 19: Essential Electrical System

The use of alternate sources of power is not at all uncommon outside of health care. What makes
health care electrical distribution systems unique is how the systems are designed. Take a hospital
for instance, it will be required to have an essential electrical systems. In most cases, the essential
electrical system will be comprised of three branches, The Life Safety Branch, the Critical Branch
and the Equipment Branch. NFPA 99 provides specific requirements not only for equipment and
systems that must be powered by the essential electrical system but also which branch of the
essential electrical system should serve those loads.

NFPA 99 and documents that it references such as NFPA 110 Standard for Emergency and
Standby Power Systems and NFPA 70 The National Electric Code® provide detailed requirements
for the electrical distribution systems in health facilities.

Life Safety Branch – within 10 seconds of loss of power, loads must be transferred to the generator.
This requires that the transfer switch(s) sense a loss of power, signal the generator(s)to start, the
generator(s) starts and comes up to speed and the Life Safety Loads are connected to the
generator. Loads that are served by the Life Safety Branch include items required to safely egress
the building and includes egress lighting, exit signs, powered doors in the path of egress, and the
fire alarm system. The life safety branch also includes elevator controls and lights, generator set

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 Fundamentals of Health Care Facility Electrical Power Systems
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accessories, medical gas alarms, and other communications and notification systems required to
egress the building.

Critical Branch – within 10 seconds, loads need to be on generator - The intent is power for “direct
patient care.” Task lighting, and electrical receptacles needed to power patient care equipment that
is essential is served by the Critical Branch. Fixed equipment that is essential to patient care is also
powered from the Critical Branch.

Equipment Branch – Some equipment, such as ventilation systems for airborne infection isolation
rooms can be served by the equipment branch and have a delayed automatic connection. This
means that the equipment is not connected to the generator within 10 seconds, but is automatically
connected after a delay. NFPA 99 does allow this equipment to be connected to the Critical Branch
and to not have a delayed transfer if the health care organization desires to do so. NFPA 99
specifies some types of equipment that can be connected to the equipment branch using a delayed
automatic connection, or a manual connection. An example of this would be equipment required for
heating. The equipment can utilize a delayed automatic connection, or can be connected manually.
Where a manual connection scheme is used, if a power outage is short, the heating systems may
not need to be transferred to the generator. If it appears that the outage will be longer, the facility
can choose to connect heating equipment to the generator.

Slide 20: Electrical Distribution

Like any engineered system, electrical power distribution systems cannot be designed and
constructed to indefinitely operate 100% of the time. Whether for a relatively new power system, or
for an older existing installation, continual assessment of the condition of the electrical power
systems and proper maintenance can mean the difference between an electrical system which
operates reliably as designed and intended as well as meets electrical codes and standards and
one that does not.

If a health care organization does not take care of the electrical distribution in their facilities, what
can happen?

• Failure of a component of the essential electrical system during a power outage

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 Fundamentals of Health Care Facility Electrical Power Systems
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• Insufficient electrical capacity to meet needs

• Creation of unsafe or dangerous conditions

Slide 21: Alternate Power Source Assessment

Let’s talk a little more about assessing the need for providing an alternate source of power.

Hospitals have emergency power supply systems (EPSS) that play a critical role in medical and
healthcare facilities, where the continuity of electrical power is vital for patients’ lives and safety.
EPS systems are made up of one or more alternate power sources which can supply the
healthcare facility with power during an interruption of the main utility-supplied power. Typically,
alternate power sources are made up of one or more diesel or gas powered generators, sized to
carry, at a minimum, any vital, critical and emergency loads. Power is transferred from the main
utility supply to the alternate power sources using automatic transfer switches (ATS) whenever the
main utility supply is interrupted. A facility may have one or several independent EPS systems.

Slide 22: Alternate Power Source Assessment

Depending on the jurisdiction of the facility, different regulatory requirements dictate how the EPS
systems need to be maintained and tested.

Many countries mandate specific compliance standards for generator testing and some require
formal reports for government agencies and for audit purposes. These compliance standards may
be mandated by federal governments, local (state/provincial) governments, or by private
organizations.

In the U.S., for example, hospitals are required to test their EPS systems monthly for 30 minutes at
or above the manufacturer’s recommended engine exhaust temperature or at a minimum load of
30% of the generators’ nameplate rating. Also, maximum transfer times of less than 10 seconds
are typically required. There are many additional testing requirements that will be studied in greater
detail in another Energy University Course.

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 Fundamentals of Health Care Facility Electrical Power Systems
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Slide 23: Alternate Power Source Assessment

Within a hospital electrical distribution network, the circuits can be divided between the normal non-
essential circuits and the essential electrical system. The non-essential circuits do not require an
alternate power source, but the essential electrical system does.

The essential electrical system includes circuits that support equipment or systems vital to the
protection of life and safety (including patient-care related circuits like the intensive care unit or
operating rooms as well as emergency lighting, alarm systems, battery chargers, and so on), and
all the electrical infrastructure equipment needed to ensure that vital or life safety equipment power
interruptions are kept to less than a maximum legislated duration.

The hospital system will include enough on-site generation to power at least the full load of the
essential electrical system.

Slide 24: Potential Points Of Failure

Next, let’s discuss some potential failure points within the essential electrical system.

It is easy to become focused on the loss of utility power as the primary threat to health facilities.
Health care facility designs may tend to rely on redundant power sources – such as multiple
services and standby generators, to protect a facility's power supply. The perception is that power
outages are the result of utility failures, so protection from utility failures will ensure a sufficient and
reliable supply of electrical service. In truth, electrical system reliability in hospitals is not quite that
simple.

A significant percentage of power failures in heath care facilities result from internal failures of the
electrical system. For example, any failure on the load side of an automatic transfer switch (ATS)
will interrupt the power supplied to a portion of the essential electrical system, and this kind of
power failure can be more serious than a utility failure. In failures on the supply side, the ATS
detects loss of service, initiates startup of the standby by generator, and then transfers the load to
the alternate source, making failures correctable if the standby generator successfully comes
online. Load side failures on the other hand are more serious because restoration of service is not
initiated by the essential electrical system and the standby generator. Part of the design strategy

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 Fundamentals of Health Care Facility Electrical Power Systems
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for health facilities is to minimize the amount of space and/or services that would be impacted by a
load side failure.

It’s important to think ahead in the design and planning of electrical systems in hospitals.
Designers can address potential points of failure in the essential electrical system by:

• Placing transfer switches close to the load

• Providing normal system receptacles in critical patient areas

• Using bypass isolation switches to facilitate maintenance

Slide 25: Summary

Let’s review some of the information we have covered in this course.

Power problems in health care facility electrical systems can have serious consequences on
human life, finances, technical operations, the patient environment, and the healthcare facility’s
image and reputation, so creating and maintaining a healthy electrical distribution system is crucial.

Essential electrical systems for hospitals consist of three branches, the Life Safety System, the
Critical System and the Equipment System.

Many codes and standards govern the electrical distribution system in healthcare facilities:

• NFPA 70: National Electrical Code

• NFPA 70E: Standard for Electrical Safety in the Workplace

• NFPA 99: Health Care Facilities Code

• NFPA 101: Life Safety Code

• NFPA 110: Standard for Emergency and Standby Power Systems

• NFPA 111: Standard on Stored Electrical Energy Emergency and Standby Power Systems

• FGI Guidelines

• Center for Medicare and Medicaid Services (CMS)

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 Fundamentals of Health Care Facility Electrical Power Systems
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• Occupational Safety & Health Administration (OSHA)

Hospitals have emergency power supply systems (EPSS) that play a critical role in medical and
healthcare facilities, where the continuity of electrical power is vital for patients’ lives and safety.

Slide 26: Thank You!

Thank you for participating in this course.

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